Paediatric Plastic Surgery – Cleft Lip, Cleft Palate Repair, and More – Melbourne, Victoria

Children born with congenital anomalies (meaning present at birth) can face self-esteem issues, as well as functional problems. Paediatric plastic surgery assists in the management of many birth anomalies found in infants, including hand differences, vascular anomalies, cleft lip, cleft palate and more, resulting in improved appearance or function.

Melbourne plastic surgeon Dr. David Ross is extensively trained in the treatment of birth anomalies of the face and hand. Following completion of his Plastic Surgery training in Melbourne, Victoria, Dr. Ross underwent advanced fellowships in paediatric plastic surgery initially at The Hospital For Sick Children in Toronto, Canada and subsequently at The Scottish Rite Children’s Hospital in Atlanta, United States. Since 1996 he has been a member of the Multidisciplinary Clinic of Cleft Palate and Facial Anomalies at Monash Medical Centre in Melbourne. He also runs another clinic at Monash Medical Centre, treating children with congenital anomalies of the hand and other conditions. With his training and experience, Dr. Ross is able to provide safe and effective surgical intervention for infants and children with cleft lip, cleft palate, and other congenital disorders, through Bayside Plastic Surgery, his private clinic based in Melbourne, Victoria.

Contact Bayside Plastic Surgery today to schedule a consultation at one of our centres in Melbourne, Victoria.

» Cleft Lip
» Cleft Palate
» Birthmarks / Vascular Anomalies
» Microtia (Underdeveloped Ear)
» Congenital Hand Deformities

Cleft Lip

A cleft lip is a common birth defect that develops while a child is still in the womb. As the upper lip begins to form, some children develop a separation between the left and right side of the upper lip. This separation, known as a cleft, can look like a small notch in the upper lip (incomplete cleft lip), or may be a complete separation of the lip that extends all the way to the base of the nose.

The recommended treatment for infants with a cleft lip is plastic surgery. Dr. David Ross offers cleft lip surgery at his Melbourne practice to repair both minimal and complete separations of the upper lip. Cleft lip surgery, performed shortly after birth, can improve the appearance of the lip and also assists to minimize potential developmental issues that may be caused by the defect if it also involves the palate, including problems with speech and feeding.

Cleft Lip Surgery

Cleft lip surgery can be undertaken at any time after birth as long as the infant is healthy. Dr. David Ross and the Monash cleft team offer surgery soon after birth in minor clefts, but in more severe cleft lip anomalies, presurgical splinting is often undertaken and plastic surgery is usually delayed until about 3 months. All cleft lip procedures are performed at a Monash Medical Centre in Melbourne, where the child can be monitored following surgery for safety. The complexity of the surgical procedure is determined by the severity of the cleft anomaly. Usually as well as repair of the cleft lip, the adjacent nasal deformity is corrected at the same time. In some severe cleft lip deformities, surgical repair may require two staged surgical procedures about 3 months apart. The surgical procedure does result in a small scar, but this will become less noticeable over time. Specific postoperative instructions can be discussed during a consultation with Dr. Ross.

To find out more about cleft lip repair, contact Bayside Plastic Surgery in Melbourne, Victoria today.

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Cleft Palate

A cleft palate is another type of birth defect that develops while a child is still in the womb. When the right and left sides of the roof of the mouth fail to grow together, a separation is formed that can be limited to the back of the mouth, or extend completely from the front to the back of the roof of the mouth. This condition, known as a cleft palate, often occurs in conjunction with a cleft lip anomaly.

The recommended treatment for a cleft palate is plastic surgery to close the defect. Plastic surgery to repair a cleft palate is more invasive than cleft lip surgery, and most plastic surgeons recommend waiting until the infant is older, between six to 18 months, before operating. Closure of the cleft palate allows for the normal development of speech and is therefore usually undertaken prior to the onset of speech. Cleft palate repair also assists with feeding and hearing. Often ventilation tubes are inserted into the ears at the time of cleft palate surgery to prevent serous otitis media, which may affect normal hearing.

Cleft Palate Surgery

In the cleft palate procedure, the defects in both the soft (muscle) palate and hard (bone) palate are repaired around the age of nine months. Repair of the alveolus (gums) is not usually undertaken at this time as bone grafting would be required. This procedure is usually delayed until the development of adult dentition, at about age of eight years. In the cleft palate repair, the residual components of the palate in the roof of the mouth are mobilized and advanced to the midline and posteriorly to allow closure of the defect. Special care is taken to reorientate the muscle of the soft palate to optimize its subsequent function in speech and swallowing. The cleft palate procedure is performed at Monash Medical Centre in Melbourne and the infant usually remains in the hospital for two to three nights following surgery to be monitored for safety. On some occasions, in very wide cleft palate deformities, complete closure of the palate defect is not possible, which may result in a residual palatal fistula (hole). Often this defect can be repaired subsequently with a small revisionary procedure.

It is important to understand that the gold standard of care for children born with cleft palate and facial anomalies is in a multidisciplinary team approach. Dr. David Ross works with a multidisciplinary team of health care professionals who all have considerable experience in the management of children with cleft palate deformities from birth until adulthood. These include oral surgeons, orthodontists, ENT surgeons, speech therapists, audiologists, dentists and geneticists. These specialists will assist in the management of all problems associated with cleft palate deformities as well as plastic surgery correction of the original deformity. Dr. David Ross can arrange contact with these specialists for any of his patients undergoing treatment for cleft palate anomalies. Also the parent support group, CleftPals Victoria will be able to provide support and assistance to parents who have a child with a cleft palate or other facial anomaly.

To find out more about cleft palate surgery, please contact Melbourne surgeon Dr. David Ross.

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Birthmarks / Vascular Anomalies

A birthmark is the popular term for a vascular anomaly, which is a collection of abnormal blood vessels that form on or just below the skin. Birthmarks of various shapes, size, colour, and texture are extremely common in newborns. Many will disappear spontaneously, but in over half of cases some sort of interventional treatment is required.

There are two main types of vascular birthmarks, haemangiomas and vascular malformations. These lesions differ in their appearance and natural history:

Haemangiomas

Haemangiomas generally emerge at birth or in the weeks following birth. They can be seen through the skin as a bright red swelling or as a tumour underneath the skin. They tend to undergo a natural history of initially rapid growth for 9-18 months and then slow involution over the following 4-5 years. Depending on their location they can disappear completely without trace, others will fade but leave some distortion of the underlying skin.

Vascular Malformations

There are a number of types of vascular malformations. The most common type is the venous malformation (Port Wine stain). This lesion is usually present at birth and grows in size commensurate with the child's growth. It will not involute but will remain throughout life, although it may darken with age. Other vascular malformations also persist throughout life and can be low or high flow arterio-venous malformations and other smaller lesions. These vascular malformations can cause cosmetic concern and lower self esteem or may impede normal activities, which would justify treatment.

Treatment of Vascular Anomalies

While most birthmarks will not need any sort of treatment, some haemangiomas are best treated by surgical excision. Dr. David Ross's philosophy regarding surgical intervention of haemangiomas is that if they are seen early enough and can be removed easily, surgical excision is justified to avoid the six year natural lifespan before complete involution. Other lesions that have the potential to affect vision, breathing or hearing are best treated surgically, although some other treatment modalities may also be available if surgery proves difficult. More superficial lesions like venous malformations such as port wine stains can generally be treated with multiple laser skin resurfacing sessions.

After a thorough evaluation at our plastic surgery centre in Melbourne, Victoria, we can recommend a treatment plan for children with vascular deformities. Contact us today to schedule a consultation with plastic surgeon David Ross.

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Microtia (Underdeveloped Ear)

Microtia is a congenital malformation of one or both ears that is visible at birth or soon after birth. There are several different classifications of microtia, which range from only a malformed earlobe to complete absence of the external ear and auditory canal. Many children born with microtia tend to develop hearing loss as a result of deformities within the middle ear and auditory canal. ENT surgeons are usually involved in correcting the hearing loss, but the ear contour can be recreated with reconstructive plastic surgery. For children with unilateral microtia (only one underdeveloped ear), reconstructive plastic surgery is not recommended until school age, when the opposing ear is fully formed and can be used as a guide to reconstruct the other ear. Reconstructive plastic surgery on children with bilateral microtia can begin as early as age four.

In the reconstructive procedure, the ear framework is created by carving a cartilage framework from the rib costal cartilage or a prefabricated polyethylene framework can be used to create the ear contour. The framework is then inserted into position in a subcutaneous pocket and modified to simulate the shape of a normal ear. A number of surgical procedures are required to achieve a complete ear reconstruction.

To find out more about reconstructive plastic surgery of the ear, please contact our Melbourne, Victoria practice today.

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Congenital Hand Deformities

There are several common hand malformations present in newborns, including syndactyly (webbed fingers), polydactyly (accessory digits), digital contracture, trigger fingers, short fingers, and more. If left untreated, these malformations can sometimes interfere with the development and function of the hand as the child grows. At our reconstructive plastic surgery practice in Melbourne, Dr. David Ross can correct congenital hand malformations at an early age to allow the hand to look and function as normally as possible in the future.

The timing of congenital hand surgery procedures can vary depending on the severity of the deformity and the development of the child. Dr. Ross can advise you when these procedures are best undertaken in a preoperative consultation.

Syndactyly (Webbed fingers) – Treatment

Syndactyly is a congenital condition where two or more fingers fuse together as a result of bone and/or tissue failing to separate in the womb. Simple syndactyly involves fusion of the soft tissue elements of the digit only, whereas complex syndactyly involves fusion of the bones as well. Surgical correction of syndactyly is usually undertaken within the first year of life. As multiple fingers can be involved, often several procedures are required to achieve improved hand function. In the surgical procedure the digital elements are separated, releasing the webbed tissue between the fingers - usually skin graft from the groin area is required to achieve wound closure. Where bones have fused in the hand, more complex hand surgery may be required to achieve improved hand appearance and function.

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Polydactyly (Accessory digits) - Treatment

Polydactyly is a condition characterised by extra digits on the hand. There can be several variations in the structure of accessory digits, each requiring a different type of treatment. In most cases, polydactyly can be definitively corrected with plastic surgery. Accessory digits are most commonly seen adjacent to the little finger or the thumb, but other variations are possible. Surgery can often correct these anomalies completely, but in some situations multiple procedures will be required. Dr. Ross will be able to advise which treatment modalities may be possible following his assessment of the child’s hand.

Please contact Bayside Plastic Surgery in Victoria to schedule a consultation with Dr. David Ross about the surgical treatment of polydactyly.

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Brachydactyly (Shortened digits) – Treatment

Brachydactyly is a congenital condition where some or all of the digits are shortened or underdeveloped. This situation can result in underdevelopment of the thumb only or all the fingers in the hand can be affected. This was the limb deformity originally seen in thalidomide children but there are a number of other conditions that result in this deformity, including Poland's Syndrome, radial club hand, Holt-Oram syndrome and others. Reconstructive plastic surgery procedures are aimed at optimizing hand function by improving digit length and mobility. This can be achieved by bone lengthening (distraction osteogenesis), digit transfer usually from the foot or in the case of underdeveloped thumb, transfer of the index finger to create a thumb (pollicization).

These surgical procedures are quite complex and involve extensive consultation and planning prior to instigation. Please contact Dr. Ross at Bayside Plastic Surgery in Victoria to discuss these conditions in further length.

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Macrodactyly (Overgrown digits) – Treatment

Macrodactyly is a rare condition where one or more of the digits are overgrown. Although it may be present at birth it can also occur in older patients as a result of abnormal soft tissue growth in the digit. Surgical correction of this condition is difficult and may require multiple surgical procedures to achieve an improved functional digit if the overgrowth involves the soft tissues only. If there is evidence of skeletal overgrowth, surgery is unlikely to be beneficial and amputation of the digit may be advisable. Dr. Ross can advise on the treatment options for this condition.

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Clasped Thumb Deformity (Thumb contracture) – Treatment

Contracture of the thumb noticed soon after birth is the most common congenital deformity of the hand. The parents usually notice that the child cannot move the thumb to grasp or grip and when they attempt to straighten the digit notice that it is locked in flexion. This is usually due to impediment of the tendon that allows the digit to move. Correction of this problem requires a short surgical procedure to release the tendon in the base of the thumb. Dr. Ross will be able to assess this problem in consultation and advise on a treatment plan to correct this condition.

To find out more about the treatment of syndactyly, polydactyly, contracture of the hand, microtia, vascular anomalies, cleft lip, cleft palate, and more, contact our plastic surgery practice in Melbourne , Victoria today.

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